The Clinic of Dr. Arrigo

Low Cholesterol Levels and the Connection to Aggressive Behavior and Depression
R. E. Morgan BS, L. A. Palinkas PhD, E. L. Barrett-Connor MD and D. L. Wingard PhD
Divisions of Epidemiology and Family Medicine, Department of Community and Family Medicine, School of Medicine, University of California, San Diego, La Jolla, California 92093-0628, U.S.A.

In several clinical trials of interventions designed to lower plasma cholesterol, the reductions in coronary heart disease mortality have been offset by an unexplained rise in suicides and other violent deaths.

Investigations into whether depressive illness is related to low plasma cholesterol concentrations in men of 50 years and older. In 1985-87, Beck depression questionnaires were obtained from 1020 white men, aged 50-89 years. Among men aged 70 years and older, depression was three times more common in the group with low plasma cholesterol than in those with higher concentrations. Depressive symptom scores correlated significantly and inversely with plasma cholesterol concentrations, even after adjustment for age, health status, number of chronic illnesses, number of medications, and exercise, as well as measured weight loss and change in plasma cholesterol in the previous 13 years.

The finding that low plasma cholesterol is associated with depressive symptoms in elderly men is compatible with observations that very low total cholesterol may be related to suicide and violent death. Since cholesterol lowering in the general population is widely recommended, this observation warrants further investigation.

The debate about possible adverse effects associated with low or lowered serum cholesterol has raised important scientific questions concerning the links between lipids and behavior. One of the most unexpected findings has been an association between cholesterol-lowering treatment and accidental death. A similar association has also emerged among studies, with higher-than-expected numbers of suicide deaths in the lowest cholesterol groups. These observations have prompted speculation that behavioral or emotional disturbances could be part of the process linking lipids and accidental death.

Two conclusions are drawn from the literature. One is that understanding the relationship between the biology of lipids and the psychobiology of mood is demonstrably an important scientific and public health issue. The second is that the introduction of new treatments or preventive programs should include a careful evaluation of the psychological as well as the physical effects.